Search

The effects of outpatient cardiac rehabilitation (OCR) implementation and home nursing-care services (HNS) use are not well defined in patients with heart failure (HF) with mid-range or preserved left-ventricular ejection fraction (EF) (HFmrEF or HFpEF). Through a post-hoc analysis of the HF registry in Hiroshima Prefecture of Japan (REAL-HF), we investigated the current conditions and significance of OCR and HNS in HFmrEF or HFpEF patients. The REAL-HF enrolled adult patients hospitalized with HF in eight regional core hospitals. Patients discharged home were followed for conditions of OCR and HNS and the primary endpoints (all-cause death or unscheduled readmission) for 1 year. The patients were classified into HF with reduced EF (< 40%) (HFrEF) or HFmrEF (40% ≤ EF < 50%) or HFpEF (EF ≥ 50%) group. We followed 195 HFrEF and 381 HFmrEF or HFpEF patients. OCR was generally underutilized, especially in HFmrEF or HFpEF patients (rate of completion [5-month program], 3.2%), whereas HFmrEF or HFpEF patients were more likely to use HNS after discharge home than HFrEF patients (44.1% vs. 27.2%, P < 0.0001). Patients with the use of HNS generally had lower scores of Mini-Mental State Examination and EuroQol 5 dimensions than those without. Multivariate analysis adjusted for medical and social factors showed that the completion of OCR was a strong negative predictor of the primary endpoints both in HFrEF (hazard ratio [HR] 0.10; 95% confidence interval [CI] 0.01–0.75; P = 0.025) and HFmrEF or HFpEF (HR 0.11; 95% CI 0.01–0.78; P = 0.028) patients, whereas the use of HNS was a positive predictor only in HFmrEF or HFpEF patients (HR 1.41; 95% CI 1.00–1.97; P = 0.047). In conclusion, continuous OCR, despite its inadequate implementation, was associated with favorable overall outcomes, while the necessity for HNS related to impaired cognitive function and quality of life was associated with poorer overall outcomes in HFmrEF or HFpEF patients discharged home. Further study is warranted to fully consider the factors related to OCR implementation and HNS use. [ABSTRACT FROM AUTHOR]

A favorable reverberation time in concert halls is a fundamental issue for room acoustic design, and various recommendations have been suggested so far. Nevertheless, one must track back more than half a century when it comes to systematic subjective experiments on this topic. In this study, binaural room impulse responses (RIRs) measured with a dodecahedral loudspeaker in concert halls, where orchestra concerts are regularly held, are used. First, signal processing is applied to RIR to equalize the dodecahedral loudspeaker response as flat and broad as possible within the audible frequency range. Then, anechoic recordings of music by piano and violin, excerpts from cadenzas, are convoluted with the equalized RIR. Next, subjective experiments are conducted to seek favorable reverberation times. Reverberance and clarity were judged by 16 music experts. From this research, the favorable reverberation times RTM (octave band average for 500 and 1000 Hz) for piano and violin solos are from 1.2 to 2.0 s and 1.8 to 2.4 s, respectively. However, the clarity index C80,3 (octave band average for 500, 1000, and 2000 Hz) needs to range from 0 to 2.4 dB and −1.6 to 0.7 dB, respectively, to meet the optimum reverberance for piano and violin. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is a common disease that changes cardiac morphology, especially in the left atrium (LA). It is now known that certain categories of functional mitral regurgitation (MR) are associated with AF; however, the influence of AF on right cardiac morphology is not fully understood. Our aim in this study was to investigate the association between AF and right cardiac morphology. This was a retrospective cohort study of 86 patients with persistent AF without other cardiac disease who underwent catheter ablation (CA). Seventy-one patients had sustained sinus rhythm (SR) (SR Group) and 15 patients had sustained AF (AF Group) during the study period. We compared the changes in the right cardiac dimensions and tricuspid regurgitation (TR) between the groups 12 months after CA. Patients' baseline echocardiographic assessments revealed that the LA volume index was significantly smaller in the SR group than in the AF group (46.8 ± 11.9 ml/m2 vs 59.3 ± 12.8 ml/m2, respectively; p < 0.01). Comparing baseline data with the 12-month follow-up data, in the SR group, right atrial area (RAA, cm2), tricuspid annular diameter (mm), and tricuspid regurgitant jet area (cm2) were significantly decreased compared with the AF group (19.5 ± 4.5–15.5 ± 3.6 vs 20.7 ± 3.6–19.7 ± 2.3; 30.5 ± 4.9–26.4 ± 3.9 vs 28.7 ± 4.0–28.8 ± 3.1; and 1.4 [interquartile range (IQR) 0.7–2.6]–0.6 [IQR 0.2–1.2] vs 1.2 [IQR 1.1–1.5]–0.9 [IQR 0.4–1.3], respectively). On multivariate analysis, change in RAA correlated with the reduction in tricuspid regurgitant jet area (R = 0.51, p < 0.001). In conclusion, successful CA for persistent AF led to right heart reverse remodeling, and our findings suggested that persistent AF was associated with RAA dilatation and TR. [ABSTRACT FROM AUTHOR]

Background: Estimation of left ventricular filling pressure (LVFP) is the essential part of the echocardiographic workup for exercise intolerance. The ratio of the mitral early filling velocity to the left ventricular global longitudinal strain (E/LVGLS) has emerged as a novel index of LVFP. This study aimed to investigate the relationship between E/LVGLS and exercise capacity. Methods and results: We retrospectively reviewed 90 patients with exertional dyspnea who underwent echocardiography and cardiopulmonary exercise test. Patients were classified into three groups according to their percent‐predicted maximal oxygen consumption (ppVo2) (G ≧ 75, ppVo2 > 75%, n = 20; G 50‐75, ppVo2 75‐50%, n = 57; G < 50, ppVo2 < 50%, n = 13). Measurements were (a) the relationship between ppVo2 and E/LVGLS and (b) the efficiency of integrated diastolic assessment using E/LVGLS, left ventricular volume, mitral annular early diastolic velocity (E′), and tricuspid regurgitation to identify the patient with impaired exercise capacity. Univariate linear regression analysis demonstrated that E/LVGLS had significant correlation with ppVo2 (ρ = 0.52, P < 0.001). The area under the ROC of E/LVGLS for ppVo2 < 50% was 0.86 (95%CI 0.75‐0.97). The DeLong test showed that E/LVGLS was efficient to detect ppVo2 < 50% than E/E′ (P = 0.007). When used in the integrated assessment of LVFP as the alternative for E/E′, E/LVGLS improved risk classification for impaired exercise capacity. Conclusion: E/LVGLS may be a more efficient index than E/E′ to identify exercise impairment as a single index and as a part of the integrated diastolic assessment. [ABSTRACT FROM AUTHOR]

Background Nearly half of patients with heart failure have normal left ventricular ejection fraction ( LVEF), but their prognosis is no better than those with reduced LVEF. Although peak oxygen consumption ( VO2) is an independent predictor of mortality in heart failure, it is unclear how cardiac function during exercise contributes to peak VO2. Therefore, we explored the useful parameters measured by exercise stress echocardiography to predict peak VO2 in patients with heart failure with preserved LVEF ( HFp EF). Methods and Results We assessed 80 patients being investigated for effort intolerance or dyspnea and finally analyzed 50 patients who satisfied the HFp EF criteria. Mean peak VO2 was 16.4±2.8 mL/kg/min. Twenty-three patients (46.0%) achieved a peak VO2 <16.0 mL/kg/min (Weber class C or D). There was a significant relationship between mitral systolic velocity (S′) and cardiac output ( CO) at rest ( R=.55, P<.0001) and peak exercise ( R=.64, P<.0001). The absolute increase in S′ from rest to peak exercise also correlated with the absolute increase in CO ( R=.32, P=.02). Multivariate logistic regression analysis showed that S′ at peak exercise independently predicted peak VO2. Receiver-operator characteristic curve analysis identified that an S′ at peak exercise of ≤8.13 cm/s predicted a peak VO2 <16.0 mL/kg/min (sensitivity 95.7%, specificity 44.4%, area under curve 0.70, 95% confidence interval 0.55-0.84, P=.004). Conclusions Mitral systolic velocity at peak exercise accurately reflects peak VO2 and may facilitate stratification of risk in patients with HFp EF. [ABSTRACT FROM AUTHOR]

Background We evaluated the diagnostic value of resting echocardiographic findings including total heart calcification ( THC) score in combination with dobutamine stress echocardiography ( DSE) for detection of myocardial ischemia. Methods Altogether, 110 patients with suspected angina pectoris underwent resting echocardiography and DSE. On the basis of resting echocardiography, we determined the THC score, left anterior descending artery diastole-to-systole velocity ratio ( LAD- DSVR), and positive myocardial velocity during isovolumic relaxation phase (VIVR) detected by color-coded tissue Doppler imaging. Myocardial ischemia was diagnosed by a 25% or greater reduction in the internal diameter of major coronary vessels with impaired fractional flow reserve ( FFR ≤0.80). Results DSE had excellent specificity (89%) but modest sensitivity (52%) for wall-motion abnormality ( WMA) analysis. Multivariate analysis showed that THC score ≥2 (odds ratio and 95% confidence interval: 4.49 [2.29-10.6]; P = 0.018), LAD- DSVR ≤1.5 (6.43 [1.39-20.3], P = 0.019), and duration of positive VIVR ≥71 msec (7.93 [3.72-12.1]; P < 0.001) were independent predictors of ischemia. The combination of inducible WMA and THC score yielded significantly higher sensitivity for ischemia detection than the inducible WMA alone (80% vs. 52%, P = 0.0008). Using receiver operating characteristics analyses, adding all three resting echocardiographic findings to clinical variables plus inducible WMA further improved prediction of ischemia (P = 0.028). Conclusions Integration of DSE and resting echocardiographic findings describing degree of heart calcification, impaired LAD flow, and extent of delayed ejection motion of the myocardium improves detection of coronary angiogram-based FFR-guided ischemia. [ABSTRACT FROM AUTHOR]

Objective acoustical parameters for halls are often measured in 1-octave bands with mid-frequencies from 125 to 4000 Hz. In reality, the frequency range of musical instruments is much wider than that, and the fundamentals of the lower notes of bass instruments are contained in 31.5 or 63 Hz bands. Overtones of fundamentals in these bands fall in 125 Hz band. This report presents subjective experiments designed to determine to what extent the overtones in 125 Hz band and higher bands influence the loudness sensation of the components in 63 Hz band. In the experiments, the 125 Hz and higher components of the musical tone are used to act as a masker against the lower component used as a maskee. The threshold of the difference between G(125 Hz) and G(lower band) that just enables one to hear the fundamental tones in the lower band is determined. Masked loudness of 63 Hz sinusoidal tone caused by partial masking noise with higher frequencies was determined based on a similar procedure to the masked loudness-matching function. The result indicates that the difference in loudness of low tone will not be noticeable even if G changed by ±2.5 to ±3 dB, at least when there are other accompanying instruments. [ABSTRACT FROM AUTHOR]

Abstract: Background: The aim of this study was to determine pioglitazone treatment restores endothelial function in hypertensive patients with impaired glucose tolerance (IGT). Methods and results: We evaluated the effects of pioglitazone treatment for 12 weeks on forearm blood flow (FBF) responses to acetylcholine and sodium nitroprusside in 34 hypertensive patients with IGT who were randomly divided into a pioglitazone group (n =17) and an amlodipine monotherapy group (n =17) and in 34 healthy subjects. Pioglitazone, but not amlodipine, increased the FBF response to acetylcholine and decreased urinary excretion of 8-hydroxy-2′-deoxyguanosine. Pioglitazone did not alter sodium nitroprusside-stimulated vasodilation. N G -monomethyl-l-arginine abolished the augmentation of FBF response to acetylcholine after pioglitazone treatment. The increase in maximal FBF response to acetylcholine correlated with the decrease in urinary excretion of 8-hydroxy-2′-deoxyguanosine. Conclusion: Pioglitazone improved endothelial function in hypertensive patients with IGT through an increase in nitric oxide bioavailability by, in part, a decrease in oxidative stress. [Copyright &y& Elsevier]

The early reflections in the room impulse response are usually defined as those observed within the initial 80 ms after the arrival of the direct sound, after which time the sound field is called reverberant. This number was chosen from measurements of other functions in a limited number of halls. In order to give an objective foundation to this time separation and to establish a physical indicator for it, a new method is proposed that defines a “transition time tL,” which is the time at which the energy correlation between the direct plus initial sound and the subsequent decaying sound first achieves a specified low value. For various halls this number is shown and its relevance as a new parameter is discussed. [ABSTRACT FROM AUTHOR]

Abstract: A simple method to detect audible echoes is proposed as an objective criterion for room acoustics. This method evaluates the perceptibility of sound reflections that are generated by an impulsive sound source and identifies from reflectograms harmful reflections perceived as echoes. Particularly with this method, the masking effect of reverberation is taken into consideration, which cannot be treated sufficiently by the existing objective criteria. The applicability to room acoustical design is verified by evaluating the impulse responses measured in real halls where audible echoes occurred. It is shown that the proposed method detects audible echoes at an accuracy of more than 90% and would be suitable for practical use. [Copyright &y& Elsevier]

The tangential plane approximation (TPA) is introduced to investigate the spherical wave reflection from smooth concave cylindrical walls, and as a practical calculation scheme, asymptotic expression of the reflected sound from that surface with a relatively large dimension is derived. The physical condition under which TPA holds is derived for the spherical wave incidence; moreover, the essential properties of the reflected sound from the curved walls, which cannot be treated by the geometrical acoustics, are discussed through the numerical calculation for infinitely long cylinders. A formula of the reflection factor of the two-dimensional curved surface is obtained for the purpose of the room acoustical design. This formula coincides with that based on the geometrical acoustics when the frequency is infinitely high. [ABSTRACT FROM AUTHOR]

The room acoustical parameters reverberation time, RT; early decay time, EDT; clarity, C80; time gravity, Tg; bass ratio, BR; strength, G; initial time delay gap, ITDG; interaural cross-correlation coefficient, IACCE, the where binaural quality index BQI equals [1-IACCE3]; and stage support, ST1 were measured in 18 major chamber-music halls in Austria, Germany, the Netherlands, Czech Republic, Switzerland, and Japan, employing procedures in accordance with ISO 3382 (1997). In combination with the architectural data, the intrinsic objective parameters for the acoustics of chamber-music halls and their variation range were examined. The results of these studies reveal four pertinent orthogonal parameters: RT, G, ITDG, BQI. General design guidelines for a chamber-music hall are presented. [ABSTRACT FROM AUTHOR]

Introduction: Central venous pressure (CVP) is frequently used in clinical practice for the assessment of volume status and cardiac preload for patients with heart failure (HF). The clinical gold standard for evaluating CVP is invasive measurements using right heart catheterization directly via central venous cava, but it is invasive with potential complications. We developed a novel monitoring algorithm termed enclosed zone CVP (ezCVP) for determining static fluid status with use of a conventional noninvasive blood pressure (NIBP). Purpose: The purpose of this study is to validate the relationship between ezCVP and CVP invasively measured by water filled catheter. Methods: 54 patients who underwent right-heart catheterization and measured ezCVP in our hospital were included. Prior to the insertion of Swan-Ganz pulmonary catheter and radial artery sheath, a blood pressure cuff was placed around right upper arm. The NIBP cuff was inflated to 45 mmHg, then the cuff pressure was decreased gradually by 5 mm Hg every 6 seconds to less than 5 mm Hg. The measurement principle for ezCVP is the same as that used for oscillatory arterial blood pressure (ABP) monitoring devices. At mean ABP, cuff pressure oscillation is maximum. In the same way, cuff pressure oscillation derived from CVP is the largest at mean CVP cuff pressure. Cuff pressure oscillation derived from ezCVP overlaps that derived from ABP. Therefore, the envelope of cuff pressure oscillation amplitude has two peaks, with the first observed at a cuff pressure equal to mean ABP and the second observed at a cuff pressure equal to mean CVP defined as ezCVP. Results: Measurements of ezCVP were feasible in 44 patients (Success group, 81.5%) and not feasible in 10 patients due to not obtain oscillatory waveform (Failure group, 18.5%). Between success group and Failure group, there were no difference in clinical characteristics. As invasive hemodynamic assessments, cardiac output measured by Swan-Ganz pulmonary catheter was higher in Success group than in Failure group (p=0.009). The validity of ezCVP was well correlated with that of CVP (R = 0.817, 95%CI 0.775-1.154, p < 0.001). Conclusions: In conclusion, we demonstrated for the first time the feasibility and usefulness of a new noninvasive method, named ezCVP. [ABSTRACT FROM AUTHOR]

Access to the original Lascaux cave, a UNESCO World Heritage site famous for its 18 000 year old paintings, has been restricted since 1963. In 2016, an accurate facsimile, Lascaux IV, was designed and built. In the original cave, Lascaux I, classical contemporary room acoustics measurement systems could not be used. However, it has been possible to perform simplified measurements in a few minutes. Similar measurements were made in Lascaux IV once completed. The data provide a unique insight of the acoustic behavior of the Lascaux cave: it shows that the two caves, the original and the copy, have similar acoustical characteristics. In both cases, in the famed Hall of Bulls, the impulse response is smooth, reverberation time is relatively long, and speech intelligibility is fair; this environment is suitable for the ceremonies that presumably took place there. Because of the precision of the copy, Lascaux IV could be used as a 1/1 scale-model of Lascaux I. Therefore, sophisticated acoustical tests could be undertaken in Lascaux IV to help specialists in their archeological investigations. For example, resonances could be precisely documented to explore the potential relationship between parietal painting positions and echoes or sound effects that may have been used in ritual ceremonies. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Several studies have shown that periodontitis is a risk factor for cardiovascular diseases. There is an association between inflammation and endothelial dysfunction. The purpose of this study was to evaluate endothelial function in patients with coronary artery disease (CAD) who had periodontitis. Methods and results: We evaluated forearm blood flow (FBF) responses to acetylcholine (ACh), an endothelium-dependent vasodilator, and to sodium nitroprusside (SNP), an endothelium-independent vasodilator, in 101 CAD patients with periodontitis (37 men and 11 women, 63±12 yr) and without periodontitis (36 men and 17 women, 62±13 yr). FBF was measured by using strain-gauge plethysmography. Circulating levels of C-reactive protein and interleukin-6 were significantly higher in the periodontitis group than in the non-periodontitis group. FBF response to ACh was significantly smaller in the periodontitis group than in the non-periodontitis group. SNP-stimulated vasodilation was similar in the two groups. Periodontal therapy reduced serum concentrations of C-reactive protein from 2.7±1.9 to 1.8±0.9mg/L (P <0.05) and interleukin-6 from 2.6±3.4 to 1.6±2.6ng/L (P <0.05) and augmented ACh-induced vasodilation from 14.7±5.2 to 20.1±6.1mL/(min100mL) tissue (P <0.05) in patients with periodontitis. The SNP-stimulated vasodilation was similar before and after treatment. After administration of NG-monomethyl-l-arginine, a nitric oxide synthase inhibitor, FBF response to ACh was similar before and after treatment. Conclusion: These findings suggest that periodontitis is associated with endothelial dysfunction in patients with CAD through a decrease in nitric oxide bioavailability. Systemic inflammation may be, at least in part, a cause and predictor of progression of endothelial dysfunction. [Copyright &y& Elsevier]

The development of a comprehensive assessment tool based on the International Classification of Functioning, Disability, and Health (ICF) for elderly patients with heart failure is urgently required. In this study, we classified the ICF categories relevant to heart failure in the elderly through a Delphi survey (3-step questionnaire survey) of 108 Registered Instructors of Cardiac Rehabilitation in the Hiroshima Prefecture. Questionnaires were conducted using postal mail or a web-based platform. The survey was conducted three times, and the survey results were provided as feedback to the participants in the second and third rounds. More than 80% of the respondents selected categories according to the ICF core set methodology. Data were collected from December 2018 to March 2019, with 67, 54, and 46 participants in the first, second, and third rounds, respectively. A total of 58 ICF items were adopted based on the results: 27 body function items, 4 body structure items, 20 activity and participation items, and 7 environmental factor items. This study is characterised by the inclusion of a large number of ICF items for mental function. This result seems to be influenced by the increasing interest in cognitive dysfunction in elderly patients with heart failure. The ICF categories selected for this study allow for a comprehensive assessment of clients for occupational therapy. The findings of this study are expected to provide a basis for an outcome measure to determine the effectiveness of occupational therapy for these patients. [ABSTRACT FROM AUTHOR]

Coronary flow reserve (CFR) reflects the functional capacity of microcirculation to adapt to blood demand during increased cardiac work. We tested the hypothesis that aging had impacts on coronary flow velocities and CFR in patients with no evidence of myocardial perfusion abnormality on single photon emission computed tomography (SPECT). Seventy-six patients undergoing transthoracic Doppler echocardiography with no evidence of myocardial perfusion abnormality on SPECT were enrolled in this study. CFR was defined as the ratio of hyperemic to resting peak diastolic coronary flow velocity. Patients were divided into the three groups based on age: 17 patients aged less than 70 years (Group I), 38 patients aged 70–79 years (Group II), and 21 patients aged 80 years or more (Group III). Compared with Group I, CFR was significantly lower in Group II (p < 0.01) and Group III (p < 0.01). Multivariate linear regression analysis showed that female (β = − 0.26, p = 0.03), cigarette smoking (β = − 0.32, p = 0.004), hemoglobin level (β = − 0.40, p = 0.001) and LV mass index (β = 0.24, p = 0.03) were determinants for resting coronary flow velocity. On the other hand, age (β = -0.30, p = 0.008), hemoglobin level (β = -0.47, p < 0.001) and LV mass index (β = 0.24, p = 0.04) were determinants for hyperemic coronary flow velocity. Age was only determinant for CFR (β = -0.48, p < 0.001). Our data suggested that that aging had a decreased effect on hyperemic coronary flow velocity rather than resting coronary flow velocity, and was further associated with impaired CFR in patients with no evidence of myocardial perfusion abnormality. [ABSTRACT FROM AUTHOR]

The dipeptidyl peptidase-4 inhibitor saxagliptin is a widely used antihyperglycemic agent in patients with type 2 diabetes. The purpose of this study was to evaluate the effects of saxagliptin on endothelial function in patients with type 2 diabetes. This was a prospective, multicenter, interventional study. A total of 34 patients with type 2 diabetes were enrolled at four university hospitals in Japan. Treatment of patients was initially started with saxagliptin at a dose of 5 mg daily. Assessment of endothelial function assessed by flow-mediated vasodilation (FMD) and measurement of stromal cell-derived factor-1α (SDF-1α) were conducted at baseline and at 3 months after treatment with saxagliptin. A total of 31 patients with type 2 diabetes were included in the analysis. Saxagliptin significantly increased FMD from 3.1 ± 3.1% to 4.2 ± 2.4% (P = 0.032) and significantly decreased total cholesterol from 190 ± 24 mg/dL to 181 ± 25 mg/dL (P = 0.002), glucose from 160 ± 53 mg/dL to 133 ± 25 mg/dL (P < 0.001), HbA1c from 7.5 ± 0.6% to 7.0 ± 0.6% (P < 0.001), urine albumin-to-creatinine ratio from 63.8 ± 134.2 mg/g to 40.9 ± 83.0 mg/g (P = 0.043), and total SDF-1α from 2108 ± 243 pg/mL to 1284 ± 345 pg/mL (P < 0.001). These findings suggest that saxagliptin is effective for improving endothelial function. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to evaluate acute effects of coffee with a high content of chlorogenic acids and different hydroxyhydroquinone contents on postprandial endothelial dysfunction. Methods: This was a single-blind, randomized, placebo-controlled, crossover-within-subject clinical trial. A total of 37 patients with borderline or stage 1 hypertension were randomized to two study groups. The participants consumed a test meal with a single intake of the test coffee. Subjects in the Study 1 group were randomized to single intake of coffee with a high content of chlorogenic acids and low content of hydroxyhydroquinone or coffee with a high content of chlorogenic acids and a high content of hydroxyhydroquinone with crossover. Subjects in the Study 2 group were randomized to single intake of coffee with a high content of chlorogenic acids and low content of hydroxyhydroquinone or placebo coffee with crossover. Endothelial function assessed by flow-mediated vasodilation and plasma concentration of 8-isoprostanes were measured at baseline and at 1 and 2 h after coffee intake. Results: Compared with baseline values, single intake of coffee with a high content of chlorogenic acids and low content of hydroxyhydroquinone, but not coffee with a high content of chlorogenic acids and high content of hydroxyhydroquinone or placebo coffee, significantly improved postprandial flow-mediated vasodilation and decreased circulating 8-isoprostane levels. Conclusions: These findings suggest that a single intake of coffee with a high content of chlorogenic acids and low content of hydroxyhydroquinone is effective for improving postprandial endothelial dysfunction. Clinical Trial Registration: URL for Clinical Trial: https://upload.umin.ac.jp; Registration Number for Clinical Trial: UMIN000013283. [ABSTRACT FROM AUTHOR]

Backgrounds Nitroglycerine-induced vasodilation (NID) is usually assessed as a control test for flow-mediated vasodilation (FMD). However, NID per se is impaired in patients with high cardiovascular risk. The purpose of this study was to investigate the associations of chronic kidney disease (CKD) with NID and FMD. Methods We measured NID and FMD in a total of 1567 adult subjects without end-stage renal disease (ESRD), 28% of whom had CKD as judged by measurements of estimated glomerular filtration rate (995 men and 572 women; mean age, 59.0 ± 16.9 years; age range, 18 to 92 years). Results NID was significantly smaller in patients with CKD than in those without CKD (10.8 ± 6.0% vs. 12.7 ± 5.7%, P < 0.001). The prevalence of vascular smooth muscle dysfunction, defined as NID of less than the division point for the lowest quartile, was significantly higher in patients with CKD than in those without CKD (37.5% vs. 21.5%, P < 0.001). Multivariate analysis revealed that CKD was independently associated with vascular smooth muscle dysfunction (OR: 1.36, 95% CI: 1.02 to 1.81, P = 0.04). FMD was significantly smaller in patients with CKD than in those without CKD (3.1 ± 2.8% vs. 4.0 ± 3.0%, P < 0.001). The prevalence of endothelial dysfunction, defined as FMD of less than the division point for the lowest quartile, was significantly higher in patients with CKD than in those without CKD (31.7% vs. 23.1%, P = 0.002). However, CKD was not independently associated with endothelial dysfunction in an age- and sex-adjusted model (OR: 0.95, 95% CI: 0.71 to 1.26, P = 0.72). Conclusions Non-ESRD CKD is independently associated with vascular smooth muscle dysfunction but not with endothelial dysfunction. [ABSTRACT FROM AUTHOR]

Background: Patients with heart failure (HF) are reportedly at high risk for ‘all-cause’ re-hospitalization. A biomarker for HF, N-terminal pro-brain natriuretic peptide (NT-proBNP), enables to simply detect patients with possible HF (pHF). We examined the hospitalization and medical cost of Japanese patients detected by an elevated serum NT-proBNP, and also evaluated the effects of institutional team approaches for HF on their all-cause hospitalizations. Methods: We retrospectively extracted all adult patients with serum NT-proBNP ≥400 pg/ml measured between January and March 2012 in Hiroshima University Hospital as pHF-positive patients. We studied their all-cause hospitalization records during the past 3-year period. We also extracted all pHF-negative patients with NT-proBNP <400 pg/ml and studied as well. In the pHF-positive patients followed for 3 years after starting interprofessional team approaches to prevent the onset and exacerbation of HF in the hospital, we compared the hospitalization and medical cost between the 3-year periods before and after the start of the team approaches. Results: We enrolled 432 pHF-positive and 485 pHF-negative patients with one or more hospitalization records. Compared to the pHF-negative patients, the pHF-positive patients had longer total hospitalization days (median [interquartile range], 30 [13–58] versus. 18 [8–39], p <0.0001) and higher total medical cost for hospitalizations (2.42 [1.07–5.08] versus. 1.80 [0.79–3.65] million yen, p <0.0001). A subset of 303 pHF-positive patients was followed for 3 years after starting the team approaches, and we found that both total hospitalization days (30 [13–57] to 8 [0–31]) and medical cost for hospitalizations (2.59 [1.37–5.05] to 0.76 [0–2.38] million yen) showed marked reduction in them. Conclusions: Patients with an elevated serum NT-proBNP have longer hospitalizations and higher costs for all-cause hospitalizations than those without. Institutional team approaches for HF may reduce them. [ABSTRACT FROM AUTHOR]

Background and aims Baseline brachial artery (BBA) diameter has been reported to be a potential confounding factor of flow-mediated vasodilation (FMD). The purpose of this study was to evaluate the relationships between BBA diameter and cardiovascular risk factors and compare the diagnostic accuracy of BBA diameter in subjects without cardiovascular risk factors and patients with cardiovascular disease (CVD) with that of FMD. Methods We measured BBA diameter and FMD in 5695 male subjects. In addition, we retrospectively investigated the incidence of cardiovascular events using another population sample consisting of 440 male subjects, to compare the accuracy of BBA diameter with that of FMD in predicting cardiovascular events. Results BBA diameter and FMD significantly correlated with age, body mass index, systolic blood pressure, diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol, and glucose as well as Framingham risk score. The prevalence of cardiovascular risk factors and CVD increased with the increase in BBA diameter and FMD. Area under the curve (AUC) value of the receiver operating characteristic (ROC) curve for BBA diameter to diagnose subjects without cardiovascular risk factors (0.59 vs. 0.62, p = 0.001) or patients with CVD (0.58 vs. 0.64, p < 0.001) was significantly lower than that for FMD. In the retrospective study, the AUC value of the ROC curve for BBA diameter to predict first major cardiovascular events was significantly lower than that of FMD (0.50 vs. 0.62, p = 0.03). Conclusions In men, BBA diameter was inferior to FMD for assessment of cardiovascular risk. [ABSTRACT FROM AUTHOR]

Cardiopulmonary exercise testing (CPET) is useful for the evaluation of patients with suspected or confirmed pulmonary hypertension (PH). End-tidal carbon dioxide pressure (PETCO) during exercise is reduced with elevated pulmonary artery pressure. However, the utility of ventilatory parameters such as CPET for detecting PH remains unclear. We conducted a review in 155 patients who underwent right heart catheterization and CPET. Fifty-nine patients had PH [mean pulmonary arterial pressure (mPAP) ≥25 mmHg]. There was an inverse correlation between PETCO at the anaerobic threshold (AT) and mPAP ( r = −0.66; P < 0.01). Multiple regression analysis showed that PETCO at the AT was independently associated with an elevated mPAP ( P = 0.04). The sensitivity and specificity of CPET for PH were 80 and 86%, respectively, when the cut-off value identified by receiver operating characteristic curve analysis for PETCO at the AT was ≤34.7 mmHg. A combination of echocardiography and CPET improved the sensitivity in detecting PH without markedly reducing specificity (sensitivity 87%, specificity 85%). Evaluation of PETCO at the AT is useful for estimating pulmonary pressure. A combination of CPET and previous screening algorithms for PH may enhance the diagnostic ability of PH. [ABSTRACT FROM AUTHOR]

Background Periodontal disease is associated with endothelial dysfunction, leading to cardiovascular disease. The effect of detailed tooth brushing behavior, not only frequency but also duration of tooth brushing, on endothelial function is unclear. The purpose of this study was to evaluate the relationships of detailed methods of tooth brushing with vascular function. Methods We evaluated flow-mediated vasodilation (FMD), nitroglycerine-induced vasodilation, and frequency and duration of tooth brushing in 896 subjects. We divided the subjects into three groups according to the frequency and duration of tooth brushing: low frequency and short duration group (< twice/day and < 2 min/procedure), low frequency or short duration group (< twice/day or < 2 min/procedure), non-low frequency and non-short duration group (≥ twice/day and ≥ 2 min/procedure). Results FMD in the low frequency and short duration group was significantly lower than FMD in the low frequency or short duration group and FMD in the non-low frequency and non-short duration group [3.1 (2.7)% vs. 4.2 (3.1)% and 4.7 (3.1)%, P = 0.001 and < 0.001, respectively]. Nitroglycerine-induced vasodilation was similar in the three groups. Using the non-low frequency and non-short duration group as the reference, the low frequency and short duration of tooth brushing group was significantly associated with an increased odds ratio of a low FMD tertile after adjustment for conventional risk factors (OR: 2.25, 95% CI: 1.39–3.59; P < 0.001). Conclusions These findings suggest that low frequency and short duration of tooth brushing are associated with endothelial dysfunction. Clinical trial registration information : URL for clinical trial: http://UMIN ; registration number for clinical trial: UMIN000003409. [ABSTRACT FROM AUTHOR]

Background Endothelial dysfunction and abnormal vascular structure may be involved in the pathogenesis of chronic heart failure (HF). The purpose of this study was to evaluate simultaneously vascular function and vascular structure in patients with heart failure with preserved ejection fraction (HFpEF). Methods We measured flow-mediated vasodilatation (FMD) and nitroglycerine-induced vasodilation as indices of vascular function and intima-media thickness (IMT) as an index of vascular structure of the brachial artery in 41 patients with HFpEF (23 men and 18 women; mean age, 66 ± 12 yr) and 165 patients without HF (95 men and 70 women; mean age, 54 ± 16 yr). Results FMD was significantly smaller in patients with HFpEF than in patients without HF (2.9 ± 2.1% versus 4.6 ± 2.7%, P = 0.0002). Nitroglycerine-induced vasodilation was significantly smaller in patients with HFpEF than in patients without HF (9.3 ± 4.1% versus 12.9 ± 4.9%, P < 0.0001). Brachial artery IMT was significantly larger in patients with HFpEF than in patients without HF (0.35 ± 0.06 mm versus 0.31 ± 0.07 mm, P = 0.0002). After adjustment for age, sex, hypertension, dyslipidemia, and diabetes mellitus, the associations remained significant between HFpEF and FMD (odds ratio, 0.79; 95% confidence interval, 0.66–0.92; P = 0.0032), nitroglycerine-induced vasodilation (odds ratio, 0.88; 95% confidence interval, 0.80–0.96; P = 0.0039), and brachial artery IMT (odds ratio, 1.08; 95% confidence interval, 1.01–1.17; P = 0.033). Conclusions These findings suggest that both endothelial dysfunction and abnormal vascular structure may contribute to the pathogenesis and maintenance of HFpEF. Endothelial function and vascular structure may be potential therapeutic targets for HFpEF. [ABSTRACT FROM AUTHOR]

Background Heavy drinking should be a predictor of endothelial dysfunction. However, there is little information on the effects of light to moderate alcohol consumption on endothelial function. The purpose of this study was to estimate the effects of dose-dependent alcohol consumption on endothelial function. Methods We measured flow-mediated vasodilation (FMD) in 2734 men aged 21–81 years who provided information on alcohol intake at 3 general hospitals. The subjects were divided into 5 groups; non-drinkers (0 g/week), light drinkers (> 0 to 140 g/week), moderate drinkers (> 140 to 280 g/week), heavy drinkers (> 280 to 420 g/week), and excessive heavy drinkers (> 420 g/week). Results FMD showed a gradual decrease in accordance with alcohol consumption in the entire study population (non-drinkers, 6.6 ± 3.4%; light drinkers, 6.2 ± 3.0%; moderate drinkers, 6.0 ± 3.0%; heavy drinkers, 5.5 ± 2.9%; excessive heavy drinkers, 5.3 ± 3.0%; P < 0.001). There was a significant difference in FMD between the light alcohol drinker group and the non-drinker group ( P = 0.015). After adjustment for other risk factors, the odds of having FMD in the lowest quartile was found to be significantly increased in the 4 drinker groups than in the non-drinker group: light (OR, 1.38; 95% CI, 1.10 to 1.75), moderate (OR, 1.36; 95% CI, 1.01 to 1.82), heavy (OR, 2.05; 95% CI, 1.46 to 2.87), excessive (OR, 2.04; 95% CI, 1.43 to 2.89). Conclusion These findings suggest that FMD is impaired in relation to alcohol consumption and that FMD is significantly smaller even in light alcohol drinkers than in non-drinkers. Alcohol intake per se may be harmful for vascular function. [ABSTRACT FROM AUTHOR]

Background Pigment epithelium-derived factor (PEDF) is a glycoprotein that belongs to the superfamily of serine protease inhibitors. It is thought that PEDF plays a protective role against atherosclerosis. Clinical studies have shown that serum levels of PEDF are increased in subjects with cardiovascular risk factors. The role of PEDF in cardiovascular disease is still controversial. The purpose of this study was to evaluate the associations between serum levels of PEDF and vascular function and structure. Methods We measured serum levels of PEDF, assessed vascular function by measurements of flow-mediated vasodilation (FMD) and nitroglycerine-induced vasodilation in the brachial artery, and measured brachial artery intima-media thickness (IMT) in 150 subjects who underwent health examinations. Results and conclusions Univariate regression analysis revealed that serum level of PEDF was significantly correlated with body mass index, high-density lipoprotein cholesterol, glucose, FMD, nitroglycerine-induced vasodilation, and brachial artery IMT. Multivariate analysis revealed that serum levels of PEDF remained an independent predictor of nitroglycerine-induced vasodilation (β = − 0.20, P = 0.02) and brachial artery IMT (β = 0.14, P = 0.03) after adjustment of cardiovascular risk factors, while serum level of PEDF was not associated with FMD (β = − 0.02, P = 0.79). These findings suggest that PEDF may be a factor directly associated with atherosclerosis. The serum level of PEDF may be a new biochemical marker of atherosclerosis. [ABSTRACT FROM AUTHOR]

Background Nitroglycerine-induced vasodilation, an index of endothelium-independent vasodilation, is measured for the assessment of vascular smooth muscle cell function or alterations of vascular structure. Both coronary and brachial artery responses to nitroglycerine have been demonstrated to be independent prognostic markers of cardiovascular events. The purpose of this study was to evaluate the nitroglycerine-induced vasodilation in coronary and brachial arteries in the same patients. Methods We measured nitroglycerine-induced vasodilation in coronary and brachial arteries in 30 subjects with suspected coronary artery disease who underwent coronary angiography (19 men and 11 women; mean age, 69.0 ± 8.8 years; age range, 42–85 years). Results and conclusions The mean values of nitroglycerine-induced vasodilation in the brachial artery, left anterior descending coronary artery, and left circumflex coronary artery were 12.6 ± 5.2%, 11.6 ± 10.3%, and 11.9 ± 11.0%, respectively. Nitroglycerine-induced vasodilation in the brachial artery correlated significantly with that in the left anterior descending coronary artery (r = 0.43, P = 0.02) and that in the left circumflex coronary artery (r = 0.49, P = 0.006). There was also a significant correlation between nitroglycerine-induced vasodilation in the left anterior descending coronary artery and that in the left circumflex coronary artery (r = 0.72, P < 0.001). These findings suggest that vascular smooth muscle cell dysfunction is a systemic disorder and thus impairment of endothelium-independent vasodilation in peripheral arteries and that in coronary arteries are simultaneously present. Nitroglycerine-induced vasodilation in the brachial artery could be used as a surrogate for that in a coronary artery and as a prognostic marker for cardiovascular events. [ABSTRACT FROM AUTHOR]

Electrocardiographic left ventricular hypertrophy (ECG-LVH) gradually regressed after aortic valve replacement (AVR) in patients with severe aortic stenosis. Sokolow-Lyon voltage (SV + RV) is possibly the most widely used criterion for ECG-LVH. The aim of this study was to determine whether decrease in Sokolow-Lyon voltage reflects left ventricular reverse remodeling detected by echocardiography after AVR. Of 129 consecutive patients who underwent AVR for severe aortic stenosis, 38 patients with preoperative ECG-LVH, defined by SV + RV of ≥3.5 mV, were enrolled in this study. Electrocardiography and echocardiography were performed preoperatively and 1 year postoperatively. The patients were divided into ECG-LVH regression group ( n = 19) and non-regression group ( n = 19) according to the median value of the absolute regression in SV + RV. Multivariate logistic regression analysis was performed to assess determinants of ECG-LVH regression among echocardiographic indices. ECG-LVH regression group showed significantly greater decrease in left ventricular mass index and left ventricular dimensions than Non-regression group. ECG-LVH regression was independently determined by decrease in the left ventricular mass index [odds ratio (OR) 1.28, 95 % confidence interval (CI) 1.03-1.69, p = 0.048], left ventricular end-diastolic dimension (OR 1.18, 95 % CI 1.03-1.41, p = 0.014), and left ventricular end-systolic dimension (OR 1.24, 95 % CI 1.06-1.52, p = 0.0047). ECG-LVH regression could be a marker of the effect of AVR on both reducing the left ventricular mass index and left ventricular dimensions. The effect of AVR on reverse remodeling can be estimated, at least in part, by regression of ECG-LVH. [ABSTRACT FROM AUTHOR]

Background and aims It is established that low-density lipoprotein cholesterol is an independent risk factor for cardiovascular events. Recently, circulating triglycerides level has been focused on as a risk factor for cardiovascular events. In this study, we evaluated the associations between triglycerides and endothelial function in a general population. Methods We analyzed data for 4887 subjects who were enrolled in the FMD-Japan registry. We investigated cross-sectional associations between serum triglyceride levels and endothelial function assessed by measurement of flow-mediated vasodilation (FMD). Results Serum triglyceride levels were correlated with FMD (r = −0.12, p < 0.001). Subjects were divided into six groups based on serum triglyceride levels. FMD was significantly decreased with an increase in serum triglyceride levels (≤0.71 mmol/L, 7.0 ± 3.5%; 0.72–0.94 mmol/L, 6.3 ± 3.5%; 0.95–1.19 mmol/L, 6.0 ± 3.1%; 1.20–1.48 mmol/L, 5.8 ± 3.2%; 1.49–2.02 mmol/L, 5.7 ± 3.1%; ≥2.03 mmol/L, 5.5 ± 3.0%; p for trend <0.001). After adjustment for age, sex, and cardiovascular risk factors, including high-density lipoprotein cholesterol, serum triglyceride levels of more than 1.20 mmol/L were independently associated with the low quartile of FMD (1.20–1.48 mmol/L, odds ratio (OR) 1.41, 95% confidence interval (CI) 1.09 to 1.82; 1.49–2.02 mmol/L, OR 1.31, 95% CI 1.00 to 1.70; ≥2.03 mmol/L, OR 1.48, 95% CI 1.13 to 1.95) using serum triglyceride levels of less than 0.71 mmol/L group as the reference. Conclusions These findings suggest that triglycerides are an independent predictor of endothelial function. Lowering circulating triglyceride levels may improve endothelial function, leading to a decrease in cardiovascular events. Clinical trial registration information URL for Clinical Trial: http://UMIN ; Registration Number for Clinical Trial: UMIN000003409 [ABSTRACT FROM AUTHOR]

Objective: Rho-associated kinase (ROCK) signaling pathway has been shown to mediate various cellular functions including cell proliferation, migration, adhesion, apoptosis, and contraction, all of which may be involved in pathogenesis of atherosclerosis. Endogenous nitric oxide (NO) is well known to have an anti-atherosclerotic effect, whereas the exogenous NO-mediated cardiovascular effect still remains controversial. The purpose of this study was to evaluate the effect of exogenous NO on ROCK activity in vascular smooth muscle cells (VSMCs) in vitro and in vivo. Methods: VSMCs migration was evaluated using a modified Boyden chamber assay. ROCK activities were measured by Western blot analysis in murine and human VSMCs and aorta of mice treated with or without angiotensin II (Ang II) and/or sodium nitroprusside (SNP), an NO donor. Results: Co-treatment with SNP inhibited the Ang II-induced cell migration and increases in ROCK activity in murine and human VSMCs. Similarly, the increased ROCK activity 2 weeks after Ang II infusion in the mouse aorta was substantially inhibited by subcutaneous injection of SNP. Conclusions: These findings suggest that administration of exogenous NO can inhibit ROCK activity in VSMCs in vitro and in vivo. [ABSTRACT FROM AUTHOR]

Abstract: Background: Cardiac computed tomography angiography (CCTA) provides the simultaneous evaluation of the aortic valve, myocardium, and coronary arteries. In particular, aortic valve calcium score (AVCS) can be accurately measured on the same scanning sequence used to measure coronary artery calcification, with no additional cost or radiation exposure. We sought to evaluate the prognostic value of CCTA measures, including AVCS, in asymptomatic aortic stenosis (AS). Methods and results: Sixty-four initially asymptomatic patients with AS with a normal ejection fraction were prospectively enrolled and followed for median 29 (IQR=18–50) months. During follow-up, 27 (42%) patients experienced cardiac events, including five cardiac deaths, eleven aortic valve replacements. Multivariate Cox proportional hazards analysis identified three CCTA measures as significant predictors of cardiac events: aortic valve area (per 0.1cm2 decrease; hazard ratio [HR]: 1.19, 95% confidence interval [CI]: 1.05–1.34); multi-vessel obstructive coronary artery disease (HR: 2.84, 95% CI: 1.10–7.32); and AVCS (per 100; HR: 1.09, 95% CI: 1.04–1.15). Kaplan–Meier analysis showed that patients with AVCS greater than or equal to the median value of 723 had significantly worse outcomes than those with AVCS less than 723 (p<0.0001). The C-statistic value for cardiac events substantially increased when these CCTA measures were added to clinical characteristics plus echocardiographic peak transaortic velocity (0.913 vs. 0.702, p<0.001). Conclusions: In patients with asymptomatic AS, CCTA measures of valve area, coronary stenosis, and calcification severity provide independent and incremental prognostic value after accounting for the echocardiographic severity of stenosis. [Copyright &y& Elsevier]

This study aims to elucidate the characteristics of patients with severe nonischemic heart failure exhibiting exercise oscillatory ventilation (EOV) and the association of these characteristics with the subjective dyspnea. Forty-six patients with nonischemic heart failure who were classified into the New York Heart Association (NYHA) functional class III underwent cardiopulmonary exercise testing (CPX) and were divided into two groups according to the presence or absence of EOV. We evaluated the patients by using the Specific Activity Scale (SAS), biochemical examination, echocardiographic evaluation, results of CPX and symptoms during CPX (Borg scale), and reasons for exercise termination. EOV was observed in 20 of 46 patients. The following characteristics were observed in patients with EOV as compared with those without EOV with statistically significant differences: more patients complaining dyspnea as the reason for exercise termination, lower SAS score, higher N-terminal pro-brain natriuretic peptide level, larger left atrial dimension and volume, left ventricular end-diastolic volume, higher Borg scale score at rest and at the anerobic threshold, higher respiratory rate at rest and at peak exercise, and higher slope of the minute ventilation-to-CO2 output ratio, and lower end-tidal CO2 pressure at peak exercise. Among the subjects with NYHA III nonischemic heart failure, more patients with EOV had a stronger feeling of dyspnea during exercise as compared with those without EOV, and the subjective dyspnea was an exercise-limiting factor in many cases. [ABSTRACT FROM AUTHOR]

Abstract: Background: The aortic valve area (AVA) is usually calculated using the continuity equation (CE) in which the left ventricular outflow tract (LVOT) area is estimated assuming circular geometry. We sought to evaluate the LVOT ellipticity with 64-multidetector computed tomography (MDCT) and to assess the impact of LVOT ellipticity on the evaluation of CE-based AVA in patients with calcified aortic valves. Methods: We prospectively studied 110 patients with calcified aortic valves including 54 aortic stenosis (AS) with both 64-MDCT and transthoracic echocardiography. Double oblique transversal images for planimetry of the aortic valve and LVOT were obtained during the midsystolic phase. The short and long-axis diameters of the planimetered LVOT were measured. Results: The MDCT planimetered LVOT area was underestimated by the diameter-derived (π× r 2) LVOT area using echocardiography (444±70mm2 versus 369±63mm2; p<0.001). The mean difference in AVA values calculated using the CE and planimetry was 0.43±0.23cm2 and mean measurement error of CE-based AVA was 18%. When the CE-based AVA was corrected using the MDCT planimetered LVOT area, the measurement error decreased from 28±5 to 5±2% in patients with severe aortic stenosis (AVA<1.0cm2), whereas from 16±5 to 3±6% in others. Conclusion: Ellipticity of LVOT is associated with underestimation of AVA measurements using the CE. CE-based AVA corrected with MDCT planimetered LVOT area is useful especially in severe AS. [Copyright &y& Elsevier]

Abstract: Background: Rho-associated kinases (ROCKs) have been shown to be involved in the pathogenesis of atherosclerosis. It is clinically important to estimate the degree of ROCK activity in humans. The purpose of this study was to confirm the validity of a leukocyte ROCK parameter as an index of ROCK activity in comparison with vascular response to a ROCK inhibitor. Methods and results: We evaluated the ratio of phospho myosin-binding subunit (p-MBS) on myosin light-chain phosphatase to total MBS in peripheral leukocytes by Western blot analysis and forearm blood flow (FBF) response to the ROCK inhibitor fasudil using strain-gauge plethysmography in 36 healthy subjects and 39 patients with cardiovascular diseases. Fasudil (3, 10, 30μg/min) was infused intra-arterially for 5min at each dose. Leukocyte p-MBS/total-MBS was higher in cardiovascular diseases than in healthy subjects (0.97±0.37 vs. 0.51±0.14; P =0.002). Fasudil increased FBF from 4.9±1.2 to 14.5±5.7mL/min/100mL tissue (P <0.0001) in patients with cardiovascular diseases, while fasudil did not alter FBF in healthy subjects. There was a significant relationship between leukocyte p-MBS/total-MBS and maximal FBF response to fasudil in all subjects (r =0.72, P <0.0001). There was also a significant correlation between p-MBS/total-MBS and maximal FBF response to fasudil in patients with cardiovascular diseases (r =0.59, P <0.0001). In healthy subjects, there was no significant correlation between the two parameters. Conclusions: These findings suggest that assessment of leukocyte ROCK activity is minimally invasive and does not require pharmacologic intervention using ROCK inhibitors. Leukocyte p-MBS/total-MBS may be useful for evaluating ROCK activity in a clinical setting. [ABSTRACT FROM AUTHOR]

Caffeine is the most widely used pharmacologic substance in the world. It is found in common nonessential grocery items (e.g., coffee, tea, cocoa, and chocolate). The effects of caffeine on cardiovascular diseases, including hypertension, remain controversial, and there is little information on its direct effect on vascular function. The purpose of this study was to determine the effect of caffeine on endothelial function in humans. This study was a double-blind, randomized placebo and active drug study. Forearm blood flow (FBF) responses to acetylcholine (ACh), an endothelium-dependent vasodilator, and to sodium nitroprusside, an endothelium-independent vasodilator, were evaluated in healthy young men before and after the oral administration of caffeine 300 mg (n = 10) or placebo (n = 10). FBF was measured by using a strain-gauge plethysmograph. Caffeine significantly increased systolic and diastolic blood pressures by 6.0 ± 6.0 and 2.6 ± 3.1 mm Hg (p <0.05), respectively, but did not alter heart rate or baseline FBF. Caffeine augmented the FBF responses to ACh from 21.2 ± 7.1 to 26.6 ± 8.1 ml/min/100 ml tissue (p <0.05), whereas sodium nitroprusside–stimulated vasodilation was not altered by caffeine administration. The intra-arterial infusion of NG-monomethyl-l-arginine, a nitric oxide synthase inhibitor, abolished the caffeine-induced augmentation of FBF response to ACh. In the placebo group, the ACh- and sodium nitroprusside–stimulated vasodilation was similar before and after the follow-up period. In conclusion, these findings suggest that the acute administration of caffeine augments endothelium-dependent vasodilation in healthy young men through an increase in nitric oxide production. [Copyright &y& Elsevier]

Background: Currently the surgical decision-making of tricuspid annuloplasty for tricuspid regurgitation (TR) depends on the measurements of tricuspid annular diameter (TAD) obtained in the apical 4-chamber view on 2-dimensional transthoracic echocardiography (2DTTE). However, whether shape and orientation of the dilated annulus would affect the accuracy of 2DTTE-TAD is unknown. Methods: A total of 185 patients with moderate to severe TR with various underlying causes and 22 controls underwent 2DTTE and 3DTEE assessment of the tricuspid valve (TV). The 3DTEE-TAD defined as the maximum diameter and tricuspid annular (TA) eccentricity index defined as the minimum diameter/maximum diameter ratio, were obtained on mid-diastole frame. As an index of TA orientation, the angle between the 3D TEE-TAD and the interatrial septum parallel to the vertical axis (α°) was measured (Figure 1). Results: Compared with normal TV, TR subgroups had a larger α° irrespective of its etiology (all P <0.05 after multiple comparison) with most frequency of patients with posteriorly orientated TA in atrial fibrillation-TR (normal control, 49±10°; primary TR, 81±36°; left-sided heart disease-TR, 66±28°; atrial fibrillation-TR, 103±35°; Figure 2). An excellent correlation was found between 3DTEE-TAD and 2DTTE-TAD (r=0.88, P <0.001); but 2DTTE-TAD was significantly smaller than 3DTEE-TAD (36.6±5.3 vs 40.6±5.6 mm; P <0.001; bias, 4.0±2.7 mm; limits of agreement, –1.3 to 9.3 mm). After multivariate adjustment, a larger 3DTEE-TAD (P <0.001) and larger absolute value of 90–α° (P <0.001) were independent determinants of the bias between 3DTEE-TAD and 2DTTE-TAD. Notably, a strong curved correlation between TA orientation and the bias was observed (r=0.57, P <0.001; Figure 2). Conclusion: This 3DTEE study demonstrates various TA orientation and its impact on the measurement of 2DTTE-TAD in patients with TR, highlighting the need for reappraising methodology for the measurement of TAD. [ABSTRACT FROM AUTHOR]

Background: Persistent AF makes left side heart expansion especially left atrium, but the effect on the right side heart is unknown. The influence to right cardiac morphology with recovering from persistent AF by catheter ablation is almost uncertain even though some guidelines suggest characterize the category of tricuspid regurgitation (TR) due to persistent AF. Objectives: The aim of this study is to seek whether the recover from persistent atrial fibrillation (AF) would provide the contraction in volume of right heart and TR. Methods and Results: A total of 101 patients (60.4 ± 9.3 years, 83 male) with persistent AF continued more than one year were performed first catheter ablation in our institution for 5 years. Of those, 71 patients kept sinus rhythm (SR) at 3 month and one year after ablation (SR Group), 15 patients had AF rhythm at both times of follow up (Recurrence Group). Before catheter procedure, only left atrial (LA) size (LA volume index; 46.8 ± 11.9 vs. 59.3 ± 12.8 ml/m2, p<0.01) had significant difference in echocardiac parameters between two groups. In follow up, right atrium (RA) area (19.5 ± 4.5 vs. 15.5 ± 3.5 cm2, p<0.01), tricuspid annular diameter (28.7 ± 4.0 vs. 27.2 ± 3.8 mm, p<0.01) and TR area [1.4 (IQR 0.7 - 2.6) vs. 0.6 (IQR 0.2 - 1.2) cm2, p<0.01] decreased three month after catheter ablation and these were maintained at one-year follow up in SR Group. No parameters changed in Recurrence Group. Conclusions: In patients with persistent AF, restoration to SR makes RA area and tricuspid annular diameter decrease. Persistent AF can be the reason of right side heart enlargement and it is reversible change. [ABSTRACT FROM AUTHOR]

Background: Recent publications suggested that epicardial adipose tissue (EAT) contributes to the pathogenesis of coronary atherosclerosis. Although some studies showed the association between EAT accumulation and left ventricular (LV) diastolic dysfunction, these associations are not fully understood. Methods: We evaluated 153 patients without coronary artery disease who underwent coronary computed tomography (CT) angiography and Doppler echocardiography. We evaluated 153 patients (mean age of 60 years and 54% men) with zero coronary artery calcium score in coronary CT. Visceral adipose tissue (VAT) area was simultaneously measured by abdominal scans, and EAT volume was also calculated. These measurements were corrected by body surface area; VAT area index (VATAI), and EAT volume index (EATVI). The early diastolic mitral annular velocity at the septal (septal E') and lateral (lateral E') were measured using tissue Doppler echocardiography. Results: The mean values of BMI, VATAI, EATVI, and LVMI were 23.7 ± 3.8 kg/m2, 52.6 ± 26.4 cm2/m2, 71.3 ± 29.8 cm3/m2, and 83.3 ± 17.7 g/m2, respectively. The mean septal E' and lateral E' velocities were 7.2 ± 2.2 cm/s and 9.8 ± 2.9 cm/s, respectively. Each E' velocity was negatively correlated with EATVI (septal, R = 0.276, p < 0.001; lateral, R = 0.342, p < 0.001) and VATAI (septal, R = 0.241, p = 0.03; lateral, R = 0.255, p = 0.002; Figure). In contrast, each E' velocity was not correlated with LVMI (septal, R = 0.161, p = 0.03; lateral, R = 0.118, p = 0.14) and BMI (septal, R = 0.182, p = 0.03; lateral, R = 0.152, p = 0.06). To determine each E' velocity, we performed stepwise multiple regression analyses where all clinical parameters were entered. Diastolic blood pressure (p = 0.014), statin use (p = 0.011), LVMI (p = 0.003), and EATVI (p = 0.004) were independently correlated with septal E' velocity, and statin use (p = 0.024), LVMI (p = 0.011), and EATVI (p < 0.001) were independently correlated with lateral E' velocity. Conclusion: An increase in EATVI was associated with the decrease of early diastolic mitral annular velocity along each side of the left ventricle in patients with coronary calcium score of zero. These findings indicate that EAT accumulation may cause LV diastolic dysfunction in the early phase of coronary artery disease. [ABSTRACT FROM AUTHOR]

Introduction: The usefulness of vascular function tests for management of patients with a history of coronary artery disease (CAD) is not fully known. Methods: We measured flow-mediated vasodilation (FMD) and brachial-ankle pulse wave velocity (baPWV) in 462 patients with CAD for assessment of the predictive value of vascular function tests for future cardiovascular events in a prospective multicenter observational study. The primary outcome was coronary events, and the secondary outcome was a composite of coronary events, stroke, heart failure, and sudden death. Results: During a median follow-up period of 49.2 months, the primary outcome occurred in 56 patients and the secondary outcome occurred in 66 patients. FMD above the cutoff value of 7.1%, derived from receiver-operator curve analyses for the primary and secondary outcomes, was significantly associated with lower risk of the primary (hazard ratio, 0.27; 95% confidence interval [CI], 0.06-0.74; P=0.008) and secondary (hazard ratio, 0.32; 95% CI, 0.09-0.79; P=0.01) outcomes. baPWV above the cutoff value of 1731 cm/s was significantly associated with higher risk of the primary (hazard ratio, 1.86; 95% CI, 1.01-3.44; P=0.04) and secondary (hazard ratio, 2.19; 95% CI, 1.23-3.90; P=0.008) outcomes. Among four groups stratified according to the combination of cutoff values of FMD and baPWV, stepwise increases in the calculated risk ratio for the primary and secondary outcomes were observed. Conclusions: In patients with CAD, both FMD and baPWV were independent predictors of cardiovascular events. The combination of FMD and baPWV provided further cardiovascular risk stratification. [ABSTRACT FROM AUTHOR]

Backgrounds: Periodontal disease is independently associated with cardiovascular disease. Several lines of evidence have shown that intensive treatment for periodontal disease improves the systemic inflammation and vascular function. However, it is unclear whether tooth brushing behavior, which is basic oral care in daily life, improves cardiovascular outcome. The purpose of this study was to evaluate the impact of the detailed tooth brushing behavior on the incidence of cardiovascular events. Methods: A total of 682 subjects (423 men and 259 women, mean age of 62 years) including 197 subjects with cardiovascular disease were enrolled in the study from January 2012 to October 2016. We divided the patients into three groups according to the frequency and duration of tooth brushing: low frequency and short duration group (

Introduction: Lower urinary tract symptoms (LUTS) is common symptom and impairs quality of life in elderly men. Recently, atherosclerosis has been focused on as one of the mechanisms of LUTS. The objective of this study was to evaluate the relationships of vascular function and structure with LUTS in men and women. Methods: This was a single center cross-sectional study. A total of 583 subjects (379 men and 204 women, mean age of 64 years) including 176 subjects with cardiovascular disease were assessed vascular function by flow-mediated vasodilation (FMD) and nitroglycerine-induced vasodilation (NID), and vascular structure by brachial-ankle pulse wave velocity (baPWV), and LUTS by International Prostate Symptom Score (IPSS). Results: IPSS was significantly correlated with conventional atherosclerotic factors, Framingham risk score, FMD, NID and baPWV. Moderate to severe LUTS was independently associated with the prevalence of cardiovascular disease (OR: 1.79, 95% CI, 1.08-2.96; P=0.02) after adjusting for traditional cardiovascular risk factors. In men, FMD and NID were lower in the moderate to severe LUTS group than in the none to mild LUTS group (2.1±2.0% vs. 4.0±3.0% and 9.3±6.1% vs. 12.8±6.6%, P<0.001, respectively). baPWV was higher in the moderate to severe LUTS group than in the none to mild LUTS group (1722±386 cm/s vs. 1509±309 cm/s, P<0.001). After adjusting for confounding factors of LUTS, FMD was independently associated with decreasing IPSS (β=-0.15, P=0.01), storage subscore (β=-0.13, P=0.03) and voiding subscore (β=-0.13, P=0.04) in men, but not in women. NID and baPWV were not independently associated with IPSS in either men or women. Conclusions: In the present study, endothelial dysfunction was associated with LUTS in men. LUTS in men should be focused on as the early phenotype of atherosclerosis. Further studies are needed to determine whether LUTS can predict future cardiovascular events. [ABSTRACT FROM AUTHOR]

Background: Exercise-induced mitral regurgitation (MR) is an important prognosticator regardless of MR etiology. However, different mechanisms of exercise-induced MR according to MR subgroups remain unknown. Measured using three-dimensional (3D) transesophageal echocardiography (TEE), 3D vena contracta area (3D-VCA) has shown to be an accurate parameter to quantify MR. The aims of this study were (1) to investigate the increase between resting 3D-VCA and 3D-VCA after hand-grip exercise (Δ3D-VCA), (2) to compare the Δ3D-VCA between degenerative and functional MR. Methods: Fifty-seven symptomatic patients with moderate to severe MR (degenerative MR, n=30; functional MR, n=27) were prospectively enrolled between May 2017 and May 2018. Using 3D TEE, MV geometry (annular diameters, annular height, averaged tenting height, 3D-VCA) and hemodynamic status were measured immediately before and after 5-minute hand-grip exercise (Figure 1). Results: There was no significant difference in 3D-VCA at rest (38.7±17.2 mm2 in degenerative MR vs. 34.4±14.3 mm2 in functional MR, P =0.32). After hand-grip exercise, the 3D-VCA increased significantly in both MR subgroups, but a larger Δ3D-VCA was observed in functional MR (16.0±9.8 mm2 vs. 5.9±4.7 mm2, P <0.001; Figure 2). In functional MR, a significant augmentation in averaged tenting height was observed after hand-grip exercise (P <0.001). Univariable linear regression analysis revealed the association of Δ3D-VCA with averaged tenting height in functional MR and with blood pressure in degenerative MR (both P <0.01). Conclusions: Hand-grip exercise alters MV geometry and causes an exacerbation of MR. The effects of changes in MV geometry and their association with increased MR severity differs between degenerative and functional MR. [ABSTRACT FROM AUTHOR]